The importance of specialized sleep investigations in children with a suprasellar tumor

Abstract

Purpose Disruption of sleep has great impact on quality of life. In children with a suprasellar tumor and hypothalamic-pituitary dysfunction, the circadian rhythm may be disturbed causing sleep problems. However, also other factors may influence sleep. Awareness of these different etiologies and careful history taking with appropriate additional diagnostics will aid in restoring sleep quality. Methods We present the workup of 4 cases with a suprasellar tumor and disturbances of sleep initiation, sleep maintenance, and daytime sleepiness. In parallel, we developed a flowchart, to aid clinicians in the diagnostics of sleep problems in children after treatment for a (supra) sellar brain tumor. Results All four patients, known with hypopituitarism, presented with sleep complaints and increased daytime sleepiness. In all four, the cause of sleep problems showed to be different. In the first case, sleep evaluation revealed a severe obstructive sleep apnea, whereupon nocturnal ventilation was started. The second case revealed poor sleep hygiene in combination with an obsessive compulsive disorder. Sleep hygiene was addressed and psychiatric consultation was offered. Dexamphetamine treatment was started to reduce her obsessive compulsive complaints. The third case showed a delayed sleep phase syndrome, which improved by educational support. The fourth case revealed a secondary organic hypersomnia for which modafinil treatment was started. Conclusion Sleep disturbances in children with hypopituitarism due to a (supra) sellar tumor can have different entities which require specific therapy. Awareness of these different entities is important to enable appropriate counseling. Referral to an expertise sleep center may be advised, if standard educational support is insufficient.

Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update

“…Sleep disorders (SDs) are classified according to the third edition of the International Classification of Sleep Disorders (ICSD-3) of the American Academy of Sleep Medicine (19), which identifies seven major categories of disorders: insomnia disorders, SBDs, central disorders of hypersomnolence, circadian rhythm sleepwake disorders (CRSWDs), sleep-related movement disorders, parasomnias, and other SDs. The most frequently reported SDs in CP are EDS (11,20), central hypersomnia and secondary narcolepsy (13,14,(21)(22)(23)(24)(25)(26)(27), SBDs (7,24), and CRSWD (28)(29)(30), which require appropriate characterization and understanding of their underlying causes. Since clinical pictures may be complex and different elements may co-exist in the same patient, this may be achieved through a specific expertise in sleep diseases.…”

“…EDS was identified by M-ESS in 76% of pediatric CP and strictly related to hypothalamic involvement (31). However, M-ESS may not be sensitive enough to screen pediatric patients for EDS (58), so complete sleep evaluation is often recommended (25).…”

Prevalence of Sleep Disorders, Risk Factors and Sleep Treatment Needs of Adolescents and Young Adult Childhood Cancer Patients in Follow-Up after Treatment

“…After treatment, patients are also more at risk for obesity [ 22 ], which is a risk factor for SBD [ 13 , 23 , 24 ]. Patients with a brain tumor localized in the area involved in sleep regulation, e.g., the hypothalamus, such as patients with a craniopharyngioma, also report more sleep problems [ 25 , 26 ], such as hypersomnia or SBD [ 26 ]. Furthermore, an increased level of psychological distress, which accompanies living with childhood cancer and survivorship [ 15 , 16 , 18 ], increases the risk of insomnia, a sleep disorder precipitated and perpetuated by distress and hyperarousal [ 27 , 28 ].…”

“…The diversity of sleep disorders in childhood cancer patients was recently illustrated in a case study of childhood cancer patients with a suprasellar tumor. The sleep disturbance of each patient was caused by a different sleep disorder and warranted different treatment strategies, e.g., one patient had a sleep-related breathing disorder for which nocturnal ventilation was used and another suffered from hypersomnia for which modafinil treatment was applied [ 26 ]. This highlights the importance of detailed inspection of symptoms to diagnose and treat sleep disorders effectively.…”

Quality of Life and Sleep in Patients with Pituitary Adenoma in Relation to Tumor Type and Compression of the Optic Chiasm

“…One of the aspects of care commonly neglected in PA patients is quality of sleep, which affects many aspects of QoL [ 10 ]. Patients treated for PA suffer from various sleep disturbances, with many possible causal mechanisms, including pituitary insufficiency, hormone excess, or psychological, behavioral, or environmental factors [ 11 ]. Compression of the anatomical structures that form the circadian pacemaker may be the leading cause of disruption of circadian rhythms in patients with adenomas with suprasellar extension [ 12 ].…”